This week the lab hasn’t been able to run any bone-scans, so there have not been any participant visits in a little while. Mostly this has been a week of data entry, but I am on the board for shadowing this Thursday’s patient visit! I also got to shadow Sean as he prepared blood samples for human DNA extraction.

Dr. Calarge has taken it upon himself to help me better understand the methods he uses to ‘strategically converse’ with a patient -how important it is for investigators to pursue specific yes/no facts while also respectfully listening to what the patient considers important.

I’ve been listening to books on tape while I do data entry, and one quote from The Death of Ivan Ilyich (about a judge) resonated with me as I thought about this kind of investigative mental health,

In his work itself, especially in his examinations, he very soon acquired a method of eliminating all considerations irrelevant to the legal aspect of the case, and reducing even the most complicated case to a form in which it would be presented on paper only in its externals, completely excluding his personal opinion of the matter, while above all observing every prescribed formality.

This week I attended another weekly ‘L.I.F.E.’ meeting where Dr. Calarge gives his input to judgements of a different kind of case. To prepare for these meetings I have been studying the DSM’s (Diagnostic and Statistical manual- the truth of human experience as agreed on by the high priests of psychiatry) entries on mood and personality disorders. During the meeting, Dr. Calarge quizzed me on the book’s criteria for a major depressive disorder (MDD) diagnosis, and I named 4 of the 5 minimum symptoms! It was intimidating, but I felt pretty good considering that my study time was split up amongst hundreds of symptom permutations. Clearly I still have a lot to learn, but I can think of few better environments than the Calarge lab to for that to happen.

At this Fellowship’s halfway point, I have learned much about the reality of standardized psychology, and its big book. Not just memorizing entries on individual disorders, but what it really means means to be ‘mentally ill’, and how we as a society deal with it. In the DSM handbook’s introduction it notes that the use of its standard criteria “enhances agreement among clinicians and investigators”. The National Institute of Mental Health strongly disagrees, and based on the medical forms I have entered as well as the L.I.F.E meetings I’ve attended thus far -so do I. Rarely are patients or the people responsible for interviewing them of the exact same mind from check-in to check-in. An interview that was conducted a week ago usually sounds much different during a later review (like how this blog post probably will). At an interview’s first listen there is little “agreement among clinicians and investigators”, but -and this is the real strength of the DSM- they are able to argue their positions until a group consensus is reached. I am starting to see the DSM almost like the U.S constitution (or Imperial Russian law, as in the case of Ivan Ilyich). Both legal and clinical standards work not so much to answer specific questions with definite answers, but rather they create a common environment for their discussion!